Emergency Department For Nonurgent Care Research Articles

One Stop: Examining the Reasons Patients Use the Emergency Department for Nonurgent Care and the Barriers They Face

IntroductionDespite the plethora of research on the use of emergency department services for nonurgent primary health care, the vast majority of this research is quantitative in nature. To date, there is little research that reports on the problem from the patients’ perspective and/or lived experience, which compromises health care providers’ understanding of the essence of the problem as described by the patients. Thus, this study will provide a qualitative description of nonurgent ED visits from the patients’ perspective. Specifically, this study answers the following research questions: 1) What are the reasons for patients and/or caregivers visiting the emergency department for nonurgent health conditions? and 2) What are the barriers experienced by patients and/or caregivers when seeking access to health care? MethodsA qualitative descriptive design with face-to-face interviews of 33 consenting participants was conducted at 4 emergency departments. All interviewed participants were triaged as nonurgent patients by the ED personnel. ResultsThree themes surfaced from the data regarding reasons for using the emergency department: 1) Practitioner referral; 2) Efficacy of care; and 3) Time saver. When describing barriers that participants experienced when seeking care outside of the emergency department for their nonurgent conditions, 3 themes that emerged are lack of primary care provider, financial difficulties, and lack of comprehensive care outside the emergency department. DiscussionThe results of the study can help inform patient-centered care and future policy initiatives that will address the practices and barriers contributing to nonurgent ED visits.

EPSDT Care and Emergency Department Visits for Non-Urgent Care: Hispanic vs. Non-Hispanic Children in a Border Community

Objectives: We examine the use of emergency departments for non-urgent care, comparing children who received recommended EPSDT services to those who do not, analyzing differences between Hispanic and Non-Hispanic children, controlling for differences in their characteristics. Methods: A retrospective, longitudinal study of a cohort of approximately 6,000 children during the years from 1999-2009 using data from hospital and emergency department (ED) claims, paediatric office visits and claims data from Medicaid (AHCCCS) and SCHIP. Three different versions of an econometric model are presented. The estimates also include the effects of health insurance coverage and the lack thereof by evaluating the records of all children age 0-19 in Yuma County who met any of the following criteria: insured by Medicaid or SCHIP at any time; or used the emergency department (ED) or any other participating provider during the ten years; or were immunized. We test if the provision of recommended EPSDT services by age two, affected the subsequent number of nonurgent care visits to hospital’s ED. Results: Children without continuous health insurance coverage are twice as likely as continuously insured children to use and ED for non-urgent care. Controlling for health insurance coverage and demographics, the receipt of recommended EPSDT care by age two significantly reduces non-urgent care visits to the ED for Hispanic children. In some instances the likelihood of such visits is cut in half. Conclusion: The results suggest that the provision of EPSDT services to the growing number of Hispanic children can yield significant benefits.

Nonurgent Use of the Emergency Department by Pediatric Patients: A Theory-Guided Approach for Primary and Acute Care Pediatric Nurse Practitioners

Providing quality, cost-effective care to children and their families in the appropriate setting is the goal of nurse practitioners in primary and acute care. However, increased utilization of the emergency department (ED) for nonurgent care threatens cost-effective quality care, interrupts continuity of care, and contributes to ED overcrowding. To date, descriptive research has identified demographics of those using the ED for nonurgent care, the chief complaints of children seeking nonurgent care, the cost to the health care system of pediatric nonurgent care, and characteristics of associated primary care settings. Using Donabedian's Model of Quality of Healthcare and a Theory of Dependent Care by Taylor and colleagues, acute and primary care pediatric nurse practitioners can incorporate interventions that will channel care to the appropriate setting and educate caregivers regarding common childhood illnesses and the value of continuity of care. By using a theoretical framework as a guide, this article will help both acute and primary care pediatric nurse practitioners understand why parents seek nonurgent care for their children in the ED and actions they can take to ensure that care is provided in an optimal setting.

Deprivation and its impact on non-urgent Paediatric Emergency Department use: are Nurse Practitioners the answer?

This article reports on the quantitative findings from a large mixed method study that determined the extent to which the provision of alternatives to an Emergency Department and Index of Relative Social Disadvantage score influenced non-urgent paediatric Emergency Department use. In Australia, there is an increasing use of Emergency Departments for the provision of non-urgent care that may be better serviced in the community. Further, despite the plethora of literature describing the characteristics of non-urgent users of Emergency Departments the link to social and community characteristics remains under explored. This 2010 retrospective analysis of the Hospital Admission Status data from the paediatric Emergency Department provided the information on attendance types and numbers along with postcode details. The postcodes in conjunction with Australia Bureau of Statistics data provided the levels of deprivation from the Index of Relative Social Deprivation scores. A logistic regression analysis determined the levels of influence of deprivation and General Practitioner or Nurse Practitioner provision on the use of Emergency Departments for non-urgent care. Rates of use for non-urgent care is higher for populations who come from areas of deprivation and have limited primary care services, such as low levels of General Practitioners. Children from areas of high deprivation and limited access to primary care were up to six times more likely to use Emergency Department for non-urgent care. Deprivation impacts on the use of paediatric Emergency Departments for non-urgent care even in countries like Australia where there is government subsidized health care.

Beliefs Regarding Mammography Screening Among Women Visiting the Emergency Department for Nonurgent Care

One in 8 US women will develop invasive breast cancer in their lifetime. Despite evidence that mammography is an effective method of early detection, certain vulnerable groups, such as those using the emergency department as a medical home, do not adhere to mammography screening guidelines, and suffer disparate mortality from breast cancer. The purpose of this study was to investigate differences in beliefs regarding mammography screening among women attending the emergency department for nonurgent care and ultimately to develop interventions that promote mammography for this vulnerable population. We explored the relationship between stage of readiness to adopt mammography behavior and barriers, benefits, and perceived susceptibility by administering scales for risk, benefits, and barriers to a sample of 110 women who had presented to the emergency department of a public hospital for nonurgent complaints or were seated in the ED waiting room. We also collected sociodemographic information and stage of readiness. Mammography adherence was about 60%. Most women who were not compliant with current guidelines were contemplators. Those who were not contemplating being screened were significantly less likely to perceive themselves to be at risk of getting breast cancer. Women who had more barriers to mammography perceived less benefit from having a mammogram. African American women perceived less benefit from having a mammogram. Mammography promotion is appropriately placed in the ED waiting room given the suboptimal rate at which this population is being screened. Beliefs regarding mammography differ for women in various stages of mammography adoption and for minority women. Understanding these differences will allow intervention in this setting to be tailored to the population. ED nurses are an important and sometimes sole point of health care contact for patients who routinely visit the emergency department. As such, they have a valuable opportunity to provide cancer screening promotion messages. It is critical that nurses in this setting understand the complexities of delivering this information and the need to do so.

461: Would Nonurgent, Uninsured Patients Prefer a Local Free Clinic Instead of the Emergency Department for Non-Urgent Care?

461: Would Nonurgent, Uninsured Patients Prefer a Local Free Clinic Instead of the Emergency Department for Non-Urgent Care?

The Busy Emergency Department

“The office is closed at this time and will reopen at 9 am tomorrow morning. If this is an emergency, please call 911 or go to the nearest emergency room.” There has been an important evolution in the practice of medicine in the past decade. An article included in this issue, “Exploring New Intake Models for the Emergency Department,” clearly highlights the emergence of the emergency department (ED) as a primary portal of entry for many patients. Within the context of the issues raised by the authors we must answer the following questions: “Why does the percentage of nonurgent ED visits as a percentage of overall visits continue to rise (ie, 10% in 2002 and 13.9% in 2005)?” “Who uses the ED for nonurgent care?” “Where are the opportunities to reduce ED overuse?” The National Quality Forum’s National Priorities Partnership (NPP) has identified eliminating overuse while ensuring the delivery of appropriate care as one of 6 national priority areas. The NPP envisions health care that promotes better health and more affordable care by continually and safely reducing the burden of unscientific, inappropriate, and excessive care including tests, drugs, procedures, office and hospital visits, and hospital stays. Making overuse a national concern will reduce harm, disparities, disease burden, and waste. Assuring access to appropriate care on a timely basis will also reduce more serious chronic disease consequences downstream. Examples include hypertension, congestive heart failure, and early detection of malignant disease. Potentially preventable ED visits is one of the 9 areas targeted by the overuse committee of the NPP. The Commonwealth Fund 2008 National Scorecard on US performance noted that 26% of adults went to the ED in the previous 2 years for conditions that could have been treated by their regular doctor, if available. The United States fared the worst in a comparison with 6 other countries (Germany, Netherlands, New Zealand, the United Kingdom, Australia, and Canada). Nationally, 60 million, or half of the 120 million annual ED visits, are potentially avoidable. In 2006, there were 119.2 million visits to hospital EDs, 15.9 million of which were considered emergent or urgent. Emergency services are often the only alternative for the uninsured or underinsured as their access to primary care services is limited. However, the New England Healthcare Institute notes that lack of timely appointments and after-hours care also drives patients to the ED. Primary care practices often instruct patients to seek care in the ED. Patients can receive care in the ED anytime—regardless of the severity of their condition—and in view of the wide array of services available in the ED, patients can receive immediate feedback about their condition. These factors contribute to the fact that all payer groups and age groups contribute to the issue of nonurgent care in the ED. This trend applies to Medicare and Medicaid beneficiaries in particular. Insured patients with a primary care alternative also inappropriately use the ED; one third of ED visits are made during regular business hours when primary care offices are open. According to statistics from the Centers for Disease Control and Prevention and the Massachusetts Division of Health Care Financing and Policy, the estimated nonurgent, preventable/avoidable ED visits in Massachusetts in 2006 were made by 22 000 patients with private insurance, 15 000 with Medicaid, 10 000 uninsured, and 9000 Medicare patients. The average cost of an ED visit is $540 more than the cost of an office visit. If we can reduce ED overuse (ie, if all 60 million avoidable ED visits were redirected to a less costly setting), there is an opportunity to improve care and a potential savings of $32 billion. Overuse of nonurgent ED services results in potentially avoidable hospital admissions in 5.5% of cases as well as higher volumes of more expensive testing. The unintended consequences of harm inherent from inappropriate testing, procedures, and hospitalizations have been well documented and affect quality and patient safety. The frequent lack of follow-up on recommendations given to the patient in the ED and poor communication with the primary care physician (if indeed there is one) add to the concerns of poor coordination of care—particularly in the elderly and patients with chronic illnesses—and ED revisits. To ensure quality, safety, and patient satisfaction when the patient arrives in the ED, the recommendations inherent in the Welch and Davidson article in this journal should be carefully reviewed. Timely access to primary care services must be a focus of quality improvement efforts if we

An Exploratory Study of Patient Acceptance of Walk-In Telemedicine Services for Minor Conditions

Though healthcare costs continue to soar, the healthcare industry lags other service industries in applying information technology to improve customer (i.e., patient) service, improve access to healthcare services, and reduce costs. One particular area of concern is overuse and overcrowding of emergency departments for nonurgent care. Telemedicine is one potentially important application of information technology in this realm. The objective of this study is to examine the antecedents of patient acceptance of walk-in telemedicine services for minor ailments. Drawing upon theoretical models in the healthcare and technology acceptance literatures and based on salient beliefs elicited during interviews with 29 potential adopters, the authors develop a conceptual model of antecedents of patient acceptance of walk-in telemedicine services for minor conditions. While relative advantage, informational influences, and relationship with one’s physician emerged as important predictors of acceptance, media richness and e-consultation diagnosticity emerged as central concerns for potential adopters. They discuss the study’s implications for research and practice and offer suggestions for future empirical studies.

Patients' Perspective on Choosing the Emergency Department for Nonurgent Medical Care: A Qualitative Study Exploring One Reason for Overcrowding

For decades it has been known that patients use emergency departments for nonurgent care needs. This study was conducted to help determine how the health care community can assist patients achieve consistent health care while meeting the patient's perceived needs. A descriptive qualitative study was conducted based on interviews with 31 persons between 22 and 43 years of age following an ED visit for a nonurgent medical need. Exploration of the patient's perception was accomplished through open-ended questions in a structured interview format. Data were analyzed using content analysis. Patients who participated in our study revealed 3 major themes: (1) They were unable to obtain an appointment with a primary care provider (PCP); (2) they were referred by the staff (not the doctor) in PCPs' offices to be evaluated in the emergency department; and (3) it took less of their time to be seen in the emergency department than it did to contact their PCP, only to then be told to go to the emergency department. The findings of this study support the need for health care providers to find ways to provide nonurgent care in a timely and efficient manner. Multiple options for providing this care need to be conceived and evaluated.

Service Expectations and Clinical Characteristics of Patients Receiving Psychiatric Emergency Services

Previous studies suggest that patients use medical emergency departments for nonurgent care. However, relatively little has been published about the use of psychiatric emergency services. Eighty-two patients who visited the psychiatric emergency department in a free-standing psychiatric hospital during July 2003 participated in a self-report survey about patients' expectations. Almost all respondents had acute psychiatric needs on presentation to the psychiatric emergency department, and 45 (75 percent) had urgent needs that required inpatient or partial hospitalization. However, there was considerable mismatch between some patients' expectations and the types of services available. Patients' use of this psychiatric emergency department was generally consistent with the department's mission, but many respondents endorsed a need for a service that was not available, such as family therapy. These findings suggest the importance of efforts to educate the public about how to obtain mental health services.

Care-giving and Care-seeking Behaviours of Parents Who Take Their Children to an Emergency Department for Non-urgent Care

This study explored the care-giving and care-seeking behaviours of parents who took their children to the emergency department (ED) of a large urban hospital in Western Canada for non-urgent care. Data were collected from a convenience sample of 114 parents during a two-week period in January 1992, using a self-administered 53-item questionnaire. The data were analyzed using nonparametric statistics (Chi-square) and thematic content analysis. Eighty-two percent of parents were unsure of or overestimated the seriousness of their child's illness or injury. Prior to attending the ED, 40% of parents administered comfort measures and 45% gave medications. Only 17% of parents used at-home reading materials, while 31% sought lay advice. Fifty-eight percent of parents did not try to contact their family physician or the ED by telephone before coming to the ED. Forty-eight percent of parents who phoned their family physician were unable to obtain advice, and those who did were almost always referred to the ED. Eighty-eight percent of those who phoned the ED were instructed to bring the child to the ED. The results suggest the need for more acceptable, accessible community primary care services.

Factors associated with emergency department utilization for nonurgent pediatric problems.

To identify specific caretaker and utilization characteristics predictive of the use of the emergency departments (EDs) for nonurgent reasons. Each year more than 20 million children in the United States seek medical care in EDs. Between one third and one half of these visits are for nonurgent reasons. A descriptive study conducted during a 6-month period. Two urban hospital EDs. A questionnaire was designed to elicit information about specific caretaker characteristics and their reasons for using the ED for their child's nonurgent medical care. Two hundred caretakers and children brought to the ED for nonacute medical care. Caretakers in this study included mothers (82%) with a mean age of 30 years, single caretakers (70%), and unemployed caretakers (60%). The average age of the children was 6.2 years. Most caretakers (92%) reported having a continuity physician for their children. Caretakers who reported being taken to the ED when they were children (P<.002) and those with Medicaid insurance (P<.001) were more likely to view the ED as the usual site of care. Being a single parent was a predictor for nonurgent visits (P<.05). Predicting which caretakers are at risk for using the ED for nonurgent care when their children are sick provides the primary care physician a means of identifying specific patients who may benefit from interventions designed to promote a more cost-effective approach to using medical resources. Arch Fam Med. 2000;9:1086-1092